Supporting better lives for people: how can health and care work together

Featured article - 10 June 2020
By Sally Warren, Director of Policy, the King's Fund

Sally Warren, Director of Policy, the King's Fund

Covid-19 has bought the interdependence between health and social care into sharp focus. But it has also shown that these services do not operate on a health and care island – they are closely dependent not only on each other but also on community capacity, housing, the voluntary sector; the list goes on. Could it be that the crisis has shown the need to think differently about how health and care services work together? And who they work with?

Better integration between health and care has long been a stated ambition but progress has been patchy, and most of the public still experience health and care services that provides disjointed care that doesn’t best fit the reality of their lives. Core to the current policy agenda for better joint working are integrated care systems (ICSs). A key feature of ICSs is the emergence of ‘systems within systems’ to focus on different aspects of their objectives. This means that within the partnership that makes up an ICS, there are also smaller partnerships centred around more local areas and populations.

The starting point for integration should be to ask why we want health and care services to work together. And the reasons should start with people and communities. We want health and care services to work together, because we know the places where people live, the jobs they have, the homes they live in, the local parks they play in, have a huge impact on a person’s health. So we want health and care services to work together to make sure the circumstances of people lives – those wider determinants of health – give them the best opportunities possible to live a healthy and happy life. But within this overall approach of supporting population health, we also know that people want individual services to be better joined up, so a person’s multiple needs are met in a way that makes sense for their lives, and not just what makes sense for statutory bodies.

This means a health and care system which is orientated towards people in places and communities, rather than to Whitehall or the town hall. Place- and neighbourhood-based partnerships can better respond to the specifics needs and aspirations of a local area and think across the full range of local services and assets to help maximise the health and wellbeing of a community. Leading in this way requires a different frame of mind. The Wigan Deal demonstrates how a council attempted to create a new relationship with its communities at the heart of its approach to service transformation – an explicit ‘deal’ that was clear about mutual responsibilities and expectations. Healthier Fleetwood , is another example of focusing on building health from within the community – where the local primary care team has worked alongside local people across the community to support health and wellbeing to get downstream of emerging health needs. The need to re-orientate services to work within and alongside communities was one of the main learning points from the response to the tragedy at Grenfell.

These kinds of transformations require energy, consistency over time and determination. They all have at their heart a different relationship between people and services. Often, they include a fundamentally different relationship with staff too. A common feature is the trust given to staff on the front line to do the right thing and know how to support individual and communities. Trusting staff to understand their communities and respond innovatively to their needs and desires can lead to not only better health and wellbeing outcomes for the local community, but better job satisfaction for staff too.

Understanding the value of each partner

For this change to work and to be sustained, we need to think about local leadership in a different way. Part of the challenge is about how to ensure the contributions from all local partners are equally welcomed, heard and acted on. This can mean looking for who (or what roles) are the key connectors between different groups – for example, between the statutory sector and communities, where local councillors and the voluntary sector can bring real strengths. The challenge for leaders is to be sure they understand the value each partner can bring and support that value to come to the fore by actively creating honest relationships. And being aware of who isn’t being heard, and why, then taking steps to rectify the absence, is important.

As the health and care sector, and indeed society, recovers and resets from Covid-19, we could create a new way of working that is much more placed based, where the statutory sector looks to its communities and its partners for solutions and invests in health and wellbeing proactively rather than responding to sickness and deficits. The stark inequalities that Covid-19 has brought into sharp focus should tell us that we need to think and act differently about health if we want to see a real change and support better lives for all. More of the same just won’t do.

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